RATC says no cap for K0009

Wednesday, April 30, 2003

ALEXANDRIA, Va. — K0009, or the code relating to manual tilt n’ space wheelchairs, may not include a price cap that the Centers for Medicare and Medicaid Services (CMS) had originally requested.

Patrick Aydelott, a council member of the Rehab and Assistive Technology Council (RATC), said the task force had sent in the K0009 code in April 2002, but CMS sent it back to the RATC requesting its payment category, the qualifications a code is considered in order for payment, be placed under an allowable amount category. Under the allowable amount category, a cap would be placed on the wheelchair and a fee schedule would be determined.

However, Aydelott said, if such a change was made, dealers would be forced to finance the wheelchair because the reimbursements from CMS would be paid back over time rather than all up front.

But the RATC resubmitted to the code application back to the CMS, along with 20 others HCPCS codes, on April 1 of this year. By doing so, it puts K0009 back under the routinely purchased category, allowing dealers to get back the full reimbursement all at once rather than putting a cap on the wheelchair.

“(CMS) put the code in there (under allowable amount), which they would like to do with certain products,” Aydelott said. “But (CMS) realized, in hindsight, (K0009) is not a rental-type product, like hospital beds for instance.”

Along with the payment category change, Aydelott said, the RATC has listed the K0009 and several other wheelchairs and accessories that had been listed as K-codes, under the E-code category, designated for DME products. The K codes were originally developed and implemented as temporary codes in the 1990s and were not expected to last more than five years in that category.

The K0009 code, along with pediatric mobility products and accessories to pediatric mobility products codes, were submitted by the RATC to CMS in April 2002. The HCFA Common Procedure Coding System (HCPCS) codes that were approved were implemented in January 2003 and those that were not were reviewed again and resubmitted the following year.

The CMS has 90 days beyond April 1 to approve the most recent code applications and the final coding decisions will be released in November 2003. The code changes are due to the upcoming adoption in October 2003 of the Health Insurance Portability and Accountability Act (HIPAA), which will mandate all private and public payers to use the HCPCS code system instead of local codes. HME